Kassahun Alemu

Malaria Infection Has Spatial, Temporal, and Spatiotemporal Heterogeneity in Unstable Malaria Transmission Areas in Northwest Ethiopia

Background Malaria elimination requires successful nationwide control efforts. Detecting the spatiotemporal distribution and mapping high-risk areas are useful to effectively target pockets of malaria endemic regions for interventions. Objective The aim of the study was to identify patterns of malaria distribution by space and time in unstable malaria transmission areas in northwest Ethiopia. Methods Data were retrieved from the monthly reports stored in the district malaria offices for the period between 2003 and 2012. Eighteen districts in the highland and fringe malaria areas were included and geo-coded for the purpose of this study. The spatial data were created in ArcGIS10 for each district. The Poisson model was used by applying Kulldorff methods using the SaTScan™ software to analyze the purely temporal, spatial and space-time clusters of malaria at a district levels. Results The study revealed that malaria case distribution has spatial, temporal, and spatiotemporal heterogeneity in unstable transmission areas. Most likely spatial malaria clusters were detected at Dera, Fogera, Farta, Libokemkem and Misrak Este districts (LLR =197764.1, p<0.001). Significant spatiotemporal malaria clusters were detected at Dera, Fogera, Farta, Libokemkem and Misrak Este districts (LLR=197764.1, p<0.001) between 2003/1/1 and 2012/12/31. A temporal scan statistics identified two high risk periods from 2009/1/1 to 2010/12/31 (LLR=72490.5, p<0.001) and from 2003/1/1 to 2005/12/31 (LLR=26988.7, p<0.001). Conclusion In unstable malaria transmission areas, detecting and considering the spatiotemporal heterogeneity would be useful to strengthen malaria control efforts and ultimately achieve elimination.

Men traveling away from home are more likely to bring malaria into high altitude villages, northwest Ethiopia.

Background Information about malaria risk factors at high altitudes is scanty. Understanding the risk factors that determine the risk of malaria transmission at high altitude villages is important to facilitate implementing sustainable malaria control and prevention programs. Methods An unmatched case control study was conducted among patients seeking treatment at health centers in high altitude areas. Either microscopy or rapid diagnostic tests were used to confirm the presence of plasmodium species. A generalized linear model was used to identify the predictors of malaria transmission in high altitude villages. Results Males (AOR = 3.11, 95%CI: 2.28, 4.23), and those who traveled away from the home in the previous month (AOR = 2.01, 95% CI: 1.56, 2.58) were strongly associated with presence of malaria in high altitude villages. Other significant factors, including agriculture in occupation (AOR = 1.41, 95% CI: 1.05, 1.93), plants used for fencing (AOR = 1.70, 95% CI: 1.18, 2.52) and forests near the house (AOR = 1.60, 95% CI: 1.15, 2.47), were found predictors for malaria in high altitude villages. Conclusion Travel outside of their home was an important risk of malaria infections acquisition. Targeting males who frequently travel to malarious areas can reduce malaria transmission risks in high altitude areas.

Prevalence and Associated Factors of Antenatal Depression among Women Attending Antenatal Care Service at Gondar University Hospital, Northwest Ethiopia

Background Depression is the most prevalent psychiatric disorder during pregnancy and is associated with psychosocial and clinical obstetric factors. Depressive disorders are not only common and chronic among women throughout the world but also principal sources of disability. The scarce information and limited attention to the problem might aggravate the consequence of the problem and can limit the intervention to be taken. Therefore, the current study was conducted to determine the prevalence and identify associated factors for antenatal depression. Methods Institutional based cross-sectional study was conducted by taking a sample of 388 pregnant women coming for ANC service at Gondar University Hospital. Systematic random sampling technique was employed to recruit the study participants. Structured, pretested and interview administered questionnaire was used to collect related information while Beck Depression Inventory (BDI) was used to assess individuals`depression condition. A cut off point with high sensitivity and specificity was determined and internal consistency of the tool was checked (Cronbach alpha = 0.82). Ep Info V. 2002 and STATA 12 were used for data entry and analyses, respectively. Adjusted Odds Ratio with its 95% CI was used to declare the statistical significance of the factors. Results Depression among pregnant women was found to be 23% (95%CI: 18.48%, 26.86%). Factors significantly associated with depression were: woman`s age (20 to 29, AOR = 0.18,95% CI:0.07,0.49), occupation (housewife, AOR = 2.57,95%CI:1.21,5.46, merchant and daily laborers, AOR = 3.44 (1.38,8.58), previous pregnancy (No, AOR = 4.74,95% CI:1.58,14.17) and previous ANC follow up pattern (irregular, AOR = 11.43,95% CI:3.68,35.49), no follow up, AOR = 11.98, 95% CI:4.73,30.33). Conclusion Depression symptoms are common in pregnant mothers in the study area and interventions that would address the aforementioned factors would benefit to tackle further complications.

Latrine use among rural households in northern Ethiopia: a case study in Hawzien district, Tigray

The present study was carried out in the rural community of Hawzien district of Ethiopia to assess the pattern of use of dry pit latrines by households and the associated factors. The study shows that only 37.4% of the households used them consistently. The rest of the households cited cultural beliefs (44%), foul smell (22.6%) and inconvenience of use (17.8%) as the major reasons for the non-use of latrines. Illiteracy in male heads of households, low monthly income and non-enrolment of households under any sanitation project by local administration were found to be the other factors for the non-use of latrines. Short distance from the households to the nearest health care institution and presence of latrines within the compounds of houses were positive factors associated with their use. Therefore, expanding and continuing components of the health care programme related to hygiene and sanitation is crucial for increasing the rate of latrine use in the study area.

Choice of initial antiretroviral drugs and treatment outcomes among HIV-infected patients in sub-Saharan Africa: systematic review and meta-analysis of observational studies

BackgroundThe effectiveness of antiretroviral therapy (ART) depends on the choice of regimens during initiation. Most evidences from developed countries indicated that there is difference between efavirenz (EFV) and nevirapine (NVP). However, the evidences are limited in resource poor countries particularly in Africa. Thus, this systematic review and meta-analysis was carried out to summarize reported long-term treatment outcomes among people on first line therapy in sub-Saharan Africa.MethodsObservational studies that reported odds ratio, relative risk, hazard ratio, or standardized incidence ratio to compare risk of treatment failure among HIV/AIDS patients who initiated ART with EFV versus NVP were systematically searched. Searches were conducted using the MEDLINE database within PubMed, Google Scholar, HINARI, and Research Gates between 2007 and 2016. Information was extracted using standardized form. Pooled risk ratios (RR) and 95% confidence intervals (CI) were calculated using random-effect, generic inverse variance method.ResultA total of 6394 articles were identified, of which, 29 were eligible for review and abstraction in sub-Saharan Africa. Seventeen articles were used for the meta-analysis. Of a total of 121,092 independent study participants, 76,719 (63.36%) were females. Of these, 40,480 (33.43%) initiated with NVP containing regimen. Two studies did not report the median CD4 cell counts at initiation. Patients who have low CD4 cell counts initiated with EFV containing regimen. The pooled effect size indicated that treatment failure was reduced by 15%, 0.85 (95%CI: 0.75–0.98), and non-nucleoside reverse transcriptase inhibitor (NNRTI) switch was reduced by 43%, 0.57 (95%CI: 0.37–0.89).ConclusionThe risk of treatment failure and NNRTI switch were lower in patients who initiated with EFV than NVP-containing regimen. The review suggests that initiation of patients with EFV-containing regimen will reduce treatment failure and NNRTI switch.

The prevalence of non-communicable diseases in northwest Ethiopia: survey of Dabat Health and Demographic Surveillance System

Objective The main objective of this study was to investigate the magnitude and associated factors of non-communicable chronic diseases (NCDs) at the Dabat Health and Demographic Surveillance System (DHDSS) site in the northwestern part of Ethiopia. Design A population-based cross-sectional study was conducted from October to December 2014. Setting HDSS site, Ethiopia. Participants A total population of 67 397 living in 16 053 households was included in the study. Measures Structured interviewer-administered questionnaire was used to collect data. Self-reported morbidity was used to ascertain NCD. A binary logistic regression model was employed to identify the determinants of NCDs. Result One thousand one hundred sixty (1.7%) (95% CI 1.62 to 1.82) participants were found with at least one type of NCD. Heart disease and hypertension which accounted for 404 (32.2%) and 401 (31.9%), of the burden, respectively, were the most commonly reported NCDs, followed by 347 (27.7%) asthma, 62 (4.9%) diabetes mellitus and 40 (3.2%) cancer cases. Advanced age (≥65 year) (adjusted OR (AOR)=19.6; 95% CI 5.83 65.70), urban residence (AOR=2.20; 95% CI 1.83 to 2.65), household food insecurity (AOR=1.71; 95% CI 1.37 to 2.12) and high income (AOR=1.28; 95% CI 1.02 to 1.59) were significantly associated with the reported history of NCDs, whereas low (AOR=0.36; 95% CI 0.31 to 0.42) and moderate (AOR=0.33; 95% CI 0.22 to 0.48) alcohol consumption, farming occupation (AOR=0.72; 95% CI 0.57 to 0.91), and work-related physical activities (AOR=0.66; 95% CI 0.50 to 0.88) were inversely associated with NCDs. Conclusion There is a high burden of NCDs at the Dabat HDSS site. Promotion of regular physical exercise and reducing alcohol consumption are essential to mitigate the burden of NCDs. In addition, preventive interventions of NCDs should be strengthened among urban dwellers, older age people and people of higher economic status.

Travel to farms in the lowlands and inadequate malaria information significantly predict malaria in villages around Lake Tana, northwest Ethiopia: a matched case–control study

BackgroundIn Ethiopia, malaria has declined in the last decade; only a small number of cases have been reported, primarily from hotspots. The contribution of house proximity to water bodies and the role of migration in malaria transmission has not yet been examined in detail in northwest Ethiopia. Individual and household-level environmental and socio-demographic drivers of malaria heterogeneity were explored contextually in meso-endemic villages around Lake Tana, northwest Ethiopia.MethodsA health facility-based paired age-sex matched case–control study involving 303 matched pairs was undertaken from 10 October 2016, to 30 June 2017. Geo-referencing of case households, control households, proximate water bodies, and health centres was carried out. A pretested and structured questionnaire was used to collect data on socio-demography, household assets, housing, travel history, and malaria intervention measures. Medians (interquartile range) were computed for continuous variables. Pearson’s Chi square/Fisher’s exact test was used to detect significant differences in proportions. Principal component analysis was performed to estimate household wealth. Stratified analysis was used to confirm confounding and interaction. A multivariable conditional logistic regression model was used to detect risk factors for malaria.ResultsOf 303 malaria cases, 59 (19.5% [15.4–24.3]) were imported malaria cases whereas 244 (80.5% [75.7–84.6]) were locally acquired malaria cases. In bivariate analysis, marital status, educational status, and bed net ownership were significantly associated with malaria cases. In multivariable adjustment, travel to malarious lowlands in the preceding month (adjusted mOR = 7.32; 95% CI 2.40–22.34), household member’s travel to malarious lowlands (adjusted mOR = 2.75; 95% CI 1.02–7.44), and inadequate health information on malaria (adjusted mOR = 1.57; 95% CI 1.03–2.41) were predictors of malaria. Stratified analysis confirmed that elevation of households and travel to malarious lowlands were not effect modifiers. Travel to malarious lowlands had a confounding effect on malaria but elevation of households did not.ConclusionsIn this study, travel to farms in the lowlands and inadequate health information on malaria were risk factors for malaria in villages around Lake Tana. This evidence is critical for the design of improved strategic interventions that consider imported malaria cases and approaches for accessing health information on malaria control in northwest Ethiopia.

Spatial distribution of antenatal care utilization and associated factors in Ethiopia: evidence from Ethiopian demographic health surveys

BackgroundAntenatal care (ANC) is one of the components of care to be provided to pregnant women. In Ethiopia, characterizing the spatial distribution of antenatal care utilization is essential to prioritize risk areas where ANC is needed and facilitate interventions. Therefore, this spatial analysis was performed to assess the spatial distribution of ANC utilization between 2000 and 2011 and to identify factors associated with ANC utilization in Ethiopia.MethodsA total of 23,179 women who had a live birth in the five years preceding the surveys were included in the study. The spatial data were created in ArcGIS10.1 for each study clusters. The Bernoulli model was used by applying Kulldorff methods using the SaTScan™ software to analyze the purely spatial clusters of ANC utilization. Multiple logistic regression analysis was used to identify predictors affecting ANC utilization.ResultsANC utilization had spatial variations across the country. Spatial scan statistics identified 49 high performing clusters (LLR = 111.92, P < 0.001) in 2000, 51 (LLR = 114.49, P < 0.001) in 2005 and, 86 (LLR = 121.53, P < 0.001) in 2011. ANC utilization was higher among mothers; with richest wealth quintiles, lowest number of birth order, who are living in urban areas, younger and educated.ConclusionThese results provide further insight into differences in ANC utilization in the country and highlight high and modest performing clusters. This could enable efficient and timely spatial targeting to improve ANC service up take in Ethiopia.

Reducing amount and frequency of meal as a major coping strategy for food insecurity

BackgroundFood insecurity is a global problem affecting many people worldwide, including approximately 220 million people in sub-Saharan Africa. Ethiopia is among the countries severely affected by hunger. However, evidence on how populations within Ethiopia cope with hunger and food insecurity is limited. This study aimed to identify household coping mechanisms in response to food insecurity at a Dabat Health and Demographic Surveillance System site.MethodsThis study used data from a re-census collected between October 2014 and December 2014.15,159 household members in thirteen kebeles of the Dabat Health and Demographic surveillance system were included. The outcome variables of the study were food insecurity and coping strategies. Household Food Insecurity Access Scale (HFIAS) was used to assess food insecurity. If food insecurity was found, families were asked about coping mechanisms used. Binary logistic regression analysis was applied to identify socio-demographic determinants of reducing amount and frequency of meal as a coping mechanism in response to food insecurity.ResultOf the 15,159 households surveyed, 6671 (44.01%) reported the presence of a food insecurity in their household. Decreasing meal frequency and portions (3733 (55.96%)), borrowing money and food (2542 (38.11%)), and receiving food and money aid (1779 (26.67%)) were among the major coping strategies used by the households. Urban dwellers (AOR 2.07: 95% CI 1.74, 2.46), mid-altitude (weyina-dega) and high-land (dega) dwellers (AOR 2.46: 95% CI 2.08, 2.92 and AOR 1.22 95% CI 1.08, 1.38 respectively), and not married persons (AOR 1.60: 95% CI 1.07, 2.39) were more likely to consume less when faced with a food insecurity (using reducing amount and frequency of meal as a coping strategy).ConclusionHouseholds in the study area experienced a very high rate of food insecurity. Decreasing meal frequency and portions was the primary coping mechanism used by the households. Due to the severe insecurity of food in their household, many people chose to reduce the amount and frequency of their meal in order to prolong the small amount of food in their house. This finding indicates a high risk for undernourishment which can exacerbate the burden of malnutrition and related diseases in the region.

Tuberculosis and HIV are the leading causes of adult death in northwest Ethiopia: evidence from verbal autopsy data of Dabat health and demographic surveillance system, 2007–2013

BackgroundReliable data on causes of death form the basis for building evidence on health policy, planning, monitoring, and evaluation. In Ethiopia, the majority of deaths occur at home and civil registration systems are not yet functional. The main objective of verbal autopsy (VA) is to describe the causes of death at the community or population level where civil registration and death certification systems are weak and where most people die at home without having had contact with the health system.MethodsCauses of death were classified and prepared based on the International Classification of Diseases (ICD-10). The cause of a death was ascertained based on an interview with next of kin or other caregivers using a standardized questionnaire that draws information on signs, symptoms, medical history, and circumstances preceding death. The cause of death, or the sequence of causes that led to death, is assigned based on the data collected by the questionnaire. The complete VA questionnaires were given to two blinded physicians and reviewed independently. A third physician was assigned to review the case when disagreements in diagnosis arose.ResultsCommunicable diseases (519 deaths [48.0%]), non-communicable diseases (377 deaths [34.8%]), and external causes (113 deaths [10.4%]) were the main causes of death between 2007 and 2013. Of communicable diseases, tuberculosis (207 deaths [19.7%]), HIV/AIDS (96 deaths [8.9%]) and meningitis (76 deaths [7.0%]) were the most common causes of death.ConclusionTuberculosis, HIV/AIDS, and meningitis were the most common causes of deaths among adults. Death due to non-communicable diseases showed an increasing trend. Increasing community awareness of infections and their interrelationships, tuberculosis case finding, effective local TB programs, successful treatment, and interventions for HIV are supremely important.BACKGROUND Reliable data on causes of death form the basis for building evidence on health policy, planning, monitoring, and evaluation. In Ethiopia, the majority of deaths occur at home and civil registration systems are not yet functional. The main objective of verbal autopsy (VA) is to describe the causes of death at the community or population level where civil registration and death certification systems are weak and where most people die at home without having had contact with the health system. METHODS Causes of death were classified and prepared based on the International Classification of Diseases (ICD-10). The cause of a death was ascertained based on an interview with next of kin or other caregivers using a standardized questionnaire that draws information on signs, symptoms, medical history, and circumstances preceding death. The cause of death, or the sequence of causes that led to death, is assigned based on the data collected by the questionnaire. The complete VA questionnaires were given to two blinded physicians and reviewed independently. A third physician was assigned to review the case when disagreements in diagnosis arose. RESULTS Communicable diseases (519 deaths [48.0%]), non-communicable diseases (377 deaths [34.8%]), and external causes (113 deaths [10.4%]) were the main causes of death between 2007 and 2013. Of communicable diseases, tuberculosis (207 deaths [19.7%]), HIV/AIDS (96 deaths [8.9%]) and meningitis (76 deaths [7.0%]) were the most common causes of death. CONCLUSION Tuberculosis, HIV/AIDS, and meningitis were the most common causes of deaths among adults. Death due to non-communicable diseases showed an increasing trend. Increasing community awareness of infections and their interrelationships, tuberculosis case finding, effective local TB programs, successful treatment, and interventions for HIV are supremely important.